Cost Effectiveness of the US Geological Survey\u27s Stream-gaging Program in New York

The U.S. Geological Survey conducted a 5-year nationwide analysis to define and document the most cost effective means of obtaining streamflow data. This report describes the stream gaging network in New York and documents the cost effectiveness of its operation; it also identifies data uses and funding sources for the 174 continuous-record stream gages currently operated (1983). Those gages as well as 189 crest-stage, stage-only, and groundwater gages are operated with a budget of $1.068 million. One gaging station was identified as having insufficient reason for continuous operation and was converted to a crest-stage gage. Current operation of the 363-station program requires a budget of$1.068 million/yr. The average standard error of estimation of continuous streamflow data is 13.4%. Results indicate that this degree of accuracy could be maintained with a budget of approximately $1.006 million if the gaging resources were redistributed among the gages. The average standard error for 174 stations was calculated for five hypothetical budgets. A minimum budget of$970,000 would be needed to operated the 363-gage program; a budget less than this does not permit proper servicing and maintenance of the gages and recorders. Under the restrictions of a minimum budget, the average standard error would be 16.0%. The maximum budget analyzed was $1.2 million, which would decrease the average standard error to 9.4%. (Author \u27s abstract

2011 Indiana Interstate Mobility Report—Summary Version

The 2011 Mobility Report—Summary Version introduces the use of crowd sourced probe data collected from vehicles and mobile devices to quantify the location and duration of congestion on Indiana interstates. The report presents a detailed case study of the I-65 corridor, as well as examples of travel time reliability information for sections of Interstates 65, 70, and 94. Summary monthly mobility statistics for all 943 centerline miles of Indiana Interstates 64, 65, 69, 70, 74, 94, and 465 are tabulated in a graphical format to facilitate comparison of mobility along those corridors

Adaptation to Climate Change in the UK Wine Sector

This research contributes to literature on private sector adaptation, examining business-level adaptation to climate change in the UK wine sector. The research adopts a temporal and relational view of adaptation, through a sector-wide, value chain lens and through considering adaptation to both climate variability and longer-term change. Using the lens of ‘a good year’ and ‘a bad year’ in the sector, we consider the role of extreme events in adaptation decision-making and learning. We focus, unusually, on both opportunities and risks of climate change. Results show businesses increasingly see climate change as an opportunity for the UK wine sector. Yet climate risks remain and propagate along value chains, through supply and demand. This produces winners and losers in ‘good years’ and ‘bad years’, as well as over longer timescales. We find businesses along the value chain take steps to engage in extensive proactive adaptation behaviour, often right from business design and development. Business relationships condition climate risk exposure and adaptive capacity and adaptation decisions within one business can influence risks and opportunities throughout the value chain. Our results also reflect organisational adaptation theories. We find businesses continually refine their adaptation strategies in response to climate variability and extreme events. They enhance adaptation learning by experimenting with new technologies and strategies. Irregular and extreme events can become important focal or tipping points in creative iteration and innovation of adaptation strategies, including for longer-term climate change. Our results stand in contrast to earlier literatures which suggest that businesses consider climate change to be too uncertain, or long-term, to engage in adaptation. Instead, climate change has become a master-narrative within the wine industry, through which sector actors often interpret their experiences and orient their business design and activities. Results indicate a strong dependence on own experience in adaptation decision making, that risks creating adaptation lock-in. We propose a typology of proactive private sector adaptation responses

Limited Education and Training for Inpatient Nurses Caring for Pregnant Women with Opioid Use Disorder

Background The opioid epidemic continues as a public health emergency Pregnant women with OUD face multiple forms of marginalization and stigma based on the complex interplay of their various social identities OUD education and training among healthcare providers, particularly nurses, who are frontline clinicians in treating perinatal OUD, are lacking and leave the workforce unprepared and under-resourced to effectively support pregnant persons with OU

Predicting blunt cerebrovascular injury in pediatric trauma: Validation of the Utah Score

Risk factors for blunt cerebrovascular injury (BCVI) may differ between children and adults, suggesting that children at low risk for BCVI after trauma receive unnecessary computed tomography angiography (CTA) and high-dose radiation. We previously developed a score for predicting pediatric BCVI based on retrospective cohort analysis. Our objective is to externally validate this prediction score with a retrospective multi-institutional cohort. We included patients who underwent CTA for traumatic cranial injury at four pediatric Level I trauma centers. Each patient in the validation cohort was scored using the “Utah Score” and classified as high or low risk. Before analysis, we defined a misclassification rate <25% as validating the Utah Score. Six hundred forty-five patients (mean age 8.6 ± 5.4 years; 63.4% males) underwent screening for BCVI via CTA. The validation cohort was 411 patients from three sites compared with the training cohort of 234 patients. Twenty-two BCVIs (5.4%) were identified in the validation cohort. The Utah Score was significantly associated with BCVIs in the validation cohort (odds ratio 8.1 [3.3, 19.8], p < 0.001) and discriminated well in the validation cohort (area under the curve 72%). When the Utah Score was applied to the validation cohort, the sensitivity was 59%, specificity was 85%, positive predictive value was 18%, and negative predictive value was 97%. The Utah Score misclassified 16.6% of patients in the validation cohort. The Utah Score for predicting BCVI in pediatric trauma patients was validated with a low misclassification rate using a large, independent, multicenter cohort. Its implementation in the clinical setting may reduce the use of CTA in low-risk patients

Leveraging High Resolution Signalized Intersection Data to Characterize Discharge Headway Distributions and Saturation Flow Rate Reliability

As highway systems become more congested, it becomes increasingly important to understand the reliability with which we can estimate important performance measures such as volume to capacity ratios, particularly as we move toward leveraging field infrastructure to obtain real-time performance measures. In 1947, Greenshields wrote a paper that characterized “green time consumed” by “car-in-line-number” that ultimately was called headway. Average headway is one of principles used by the highway capacity manual to estimate saturation flow rate at signalized intersections. However, the current analytical techniques calculate a deterministic value for saturation flow rate that does not consider the stochastic variation of saturation flow rate. This paper reviews techniques used to estimate saturation flow rate, and proposes enhanced calculation methods to group saturation flow rate estimates by queue length. Grouping saturation flow rate estimates by queue length provides a convenient framework to evaluate saturation flow rate reliability. The inter-quartile range (25% - 75%) of saturation flow rates was calculated to be 1000vph based on Greenshields’ calculation techniques. Using the proposed enhanced calculation characterizing saturation flow rate, the inter-quartile range of saturation flow rate was shown to decrease from approximately 400 vph with 5 cars in a queue to 300 vph with 10 cars in queue. Because saturation flow rate is a fundamental input to volume-to-capacity performance measures, characterizing the stochastic variation of saturation flow rates provides a basic input for assessing how reliably one can estimate important performance measures such as volume-to-capacity ratios, as well as other performance measures that build upon volume-to-capacity ratios

Study protocol: NITric oxide during cardiopulmonary bypass to improve Recovery in Infants with Congenital heart defects (NITRIC trial): a randomised controlled trial

Introduction Congenital heart disease (CHD) is a major cause of infant mortality. Many infants with CHD require corrective surgery with most operations requiring cardiopulmonary bypass (CPB). CPB triggers a systemic inflammatory response which is associated with low cardiac output syndrome (LCOS), postoperative morbidity and mortality. Delivery of nitric oxide (NO) into CPB circuits can provide myocardial protection and reduce bypass-induced inflammation, leading to less LCOS and improved recovery. We hypothesised that using NO during CPB increases ventilator-free days (VFD) (the number of days patients spend alive and free from invasive mechanical ventilation up until day 28) compared with standard care. Here, we describe the NITRIC trial protocol. Methods and analysis The NITRIC trial is a randomised, double-blind, controlled, parallel-group, two-sided superiority trial to be conducted in six paediatric cardiac surgical centres. One thousand three-hundred and twenty infants <2 years of age undergoing cardiac surgery with CPB will be randomly assigned to NO at 20 ppm administered into the CPB oxygenator for the duration of CPB or standard care (no NO) in a 1:1 ratio with stratification by age (<6 and ≥6 weeks), single ventricle physiology (Y/N) and study centre. The primary outcome will be VFD to day 28. Secondary outcomes include a composite of LCOS, need for extracorporeal membrane oxygenation or death within 28 days of surgery; length of stay in intensive care and in hospital; and, healthcare costs. Analyses will be conducted on an intention-to-treat basis. Preplanned secondary analyses will investigate the impact of NO on host inflammatory profiles postsurgery. Ethics and dissemination The study has ethical approval (HREC/17/QRCH/43, dated 26 April 2017), is registered in the Australian New Zealand Clinical Trials Registry (ACTRN12617000821392) and commenced recruitment in July 2017. The primary manuscript will be submitted for publication in a peer-reviewed journal. Trial registration number ACTRN12617000821392.</p